Brief Interventions for the Job Corps Population

1. Brief Interventions for the Job Corps Population Diane A. Tennies, Ph.D., LADC Lead TEAP Regional Health Specialist August 9, 2012

2. Learning Objectives • At the end of this webinar participants will: • 1.) Describe what constitutes a brief intervention (BI). • 2.) Articulate the positive evidence for use of BI with health care professionals. • 3.) Describe the common motivational elements of effective and empirically established brief interventions. • 4.) Begin to develop ways to implement BI's with TEAP students.

3. So what is a BRIEF Intervention? Typically defined as: A behavioral change strategy that is short in length and duration aimed at helping a person reduce or stop a problematic behavior.* Typically is immediately after a screening of some sort *Definition obtained from Brief Interventions Group SBIRT Training from 8/2011

4. Remember Screening? From the TEAP Assessment Practices Webinar 05/2012: • The term “screening” refers to the testing of individuals in a certain population to estimate the likelihoodof a specific disorder. • Screening identifies people who are likely to have a disorder, as determined by their responses to certain key questions.

5. How are we “Screening” in JC? • Drum rolling please… • New Social Intake Form (SIF) • Further training on integrating the SIF and BI’s will be happening in November 2012. • SIF via the CRAFFT now helping to identify at-risk students.

6. Screening, continued • What happens if “positive” on screening? • Further Individualized Assessment • Brief intervention (Today’s Topic) • Clinical follow-up/Referral to Treatment • Bottom Line for Screening: Screening (and brief interventions) has been shown to benefit those drinking at levels placing them at risk for increased problems but not meeting criteria for alcohol dependence/abuse

7. SIF is…. Needed foundation for implementing BRIEFINTERVENTIONS

8. Brief Interventions: History There is 40 years of research since the first controlled study and finally screening and brief intervention (SBI) are being disseminated into practice. There is substantial research on the effectiveness of SBI’s in reducing risky alcohol consumption (primarily in a primary medical setting). Evidence for the effectiveness of SBI’s in reducing risky drug use, although promising, is still accumulating. For more references see: http://www.samhsa.gov/prevention/sbirt/

9. Brief Interventions: The Basics Three Parts: • Explore the negative/positive effects of alcohol/drug use • Explore motivations to change the negative and increase confidence and competence to create change • Develop options/plans they can implement Goal is to assist students to address barriers to employability involving their alcohol and drug use

10. Brief Interventions: The Mechanics • More likely to change IF: • Empathic • Client-centered • Strength-based • Motivationally enhancing style • Focused on identifying and solving the problem • Does this sound familiar??

11. Brief Interventions: What Knowledge and Skills are Required? • Overall attitude of understanding and acceptance • Counseling skills such as active listening and helping clients explore and resolve ambivalence • A focus on immediate goals • Working knowledge of the stages-of-change model* Critical to ‘aim’ interventions to ‘match’ student’s motivational level • Knowledge of Motivational Interviewing/Enhancement Techniques *From Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series, No. 34. Center for Substance Abuse Treatment. Rockville (MD): SAMHSA.

12. Sounds More Like…. This: Or:

13. Think

14. Not

15. BI’s are Grounded in Two Models Essential for TEAP’s to Know: Stages of Change (Pre-Contemplative; Contemplative; Preparation; Action and Maintenance) Motivational Interviewing/Enhancement

16. Brief Refresher on Stage of Change

17. Brief Refresher on Motivational Interviewing • Is Engaging, Inviting, Evoking and Planning • A conversation about change • Has a purpose (to evoke and strengthen personal motivation to change) • Is collaborative • Honors autonomy & self-determination • Is evocative • Uses specific skills

18. MI: Continued • Is goal oriented • Identifies and strengths change talk • Responds in certain ways (elaboration, affirmation, reflections & summary =EARS) • Respond to resistance but does not resist • http://www.motivationalinterview.org/quick_links/about_mi.html

19. Brief Interventions: The Elements Three Elements with acronym FLO: • Provide Feedback about screening results(From the SIF) • Ask student for their reaction and views about their own drinking. Listen carefully to encourage their thinking and decision-making process. • Provide advice, and negotiate a decision about Options, including establishing a goal and developing an action plan

20. So the most effective BI’s are… Based in empirically validated interventions such as Motivational Interviewing Designed to help students generate their own motivators to change. Elicit change talk. For instance, asking about: Disadvantages of status quo Advantages of Change Optimism for Change

21. Okay but…

22. Brief Interventions: Applied Using the TEAP portion of the SIF – six questions were included for screening: C-Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs? R-Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? A-Do you ever use alcohol/drugs while you are by yourself, ALONE? F-Do you ever FORGET things you did while using alcohol or drugs? F-Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use? T-Have you gotten into TROUBLE while you were using alcohol or drugs?

23. Brief Interventions: Applied Two or more answers of yes = need for further assessment and possibility of developing problem warranting a BI* So with FLO: F: Provide Feedback on Screening results emphasizing the potential impact on employability. For instance, “Students who answer yes to these questions…” L: Listen to reaction and their views on alcohol use. Reinforce change talk. O: Develop goal as well as set up referral or follow up. *Knight et al, (2002)

24. Examples? Here is your chance for:

25. An Unusual but Effective BI (with JC Staff)!

26. Email Contents If you or the Forest Service/DOL were shocked, upset, and/or surprised by the subject of this email, guess what?  It's merely a reflection of what is being permitted on our Center.   When I shot the attached clean/sober celebratory shot, I was so in tune with getting the student a good capture, that I was ALMOST (5 frames into his shoot) oblivious to his Patron ("the #1 ultra-premium tequila in the world") T-shirt, AND his "I love boobies" bracelet (promoting breast cancer awareness...of course.)…I would like to support us in returning to a Center Norm of promptly addressing and removing such inappropriate (according to our own Student Handbook) materials from our Center. Versus the emails you typically receive about enforcing the student dress code

27. Wrapping Up